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Chapter 13
Exercise
and Diabetes
INTRODUCTION
Many of the people with the best-controlled diabetes are
those who exercise regularly. Exercise should be a normal part
of life for everyone. The dietary guidelines for Americans,
2005 recommended 60 minutes of moderate to rigorous
physical activity per day to prevent weight gain and a minimum
of 30 minutes a day to reduce the risk of chronic disease (e.g.,
type 2 diabetes). We strongly encourage regular exercise for
anyone who has diabetes, even if this means making a special
effort to plan daily exercise. Young people from our Clinic
have participated in almost every sport: football, baseball, golf,
track, swimming, wrestling, dancing, skiing, basketball, soccer,
weight lifting, horseback riding, jumping rope, jogging and
tennis. In the Figure in Chapter 14, Monitoring Blood Sugar
Control, EXERCISE is listed as one of the Big 4 factors to
help attain good sugar control. This is true for people with
either type 1 or type 2 diabetes.
Physical Activity
Goal Setting and
Problem Solving
TEACHING OBJECTIVES:
1. Discuss the importance of
exercise as a critical component
of diabetes management.
2. Explain exercise
recommendations and
precautions for people with
type 1 or type 2 diabetes.
LEARNING OBJECTIVES:
Learners (parents, child, relative or
self) will be able to:
1. List three reasons why exercise
is important.
2. Develop an exercise plan which
includes monitoring of blood
sugars, use of snacks and
medication adjustments.
137
Table 1
WHY EXERCISE IS
IMPORTANT
Exercise is important and helps people with or
without diabetes in the following ways (Table 1):
138
Figure 1
200
11.1
175
9.8
Mean Glucose
mg/dl
Sedentary
8.3
150
125
100
TIME:
7.0
Exercise
5.5
Exercise Period
4:00 - 5:15 PM
4 PM
6 PM
8 PM
10 PM 12 AM
2 AM
4 AM
6 AM
This Figure presents blood glucose (sugar) levels for the same 50 children on a sedentary day (black
circles) and an exercise day (red circles). The one hour of exercise at 4 p.m. resulted in lower
glucose levels for the next 14 hours (through the night). Insulin doses and food intake were
identical for the two days.
(Data complements of the DirecNet Study Group: J Pediatr 147,528, 2005)
139
140
Table 2
Calories Burned
Per Hour
Hiking
Light gardening/yard work
Dancing
Golf (walking and carrying clubs)
Bicycling (< 10 mph)
Walking (3.5 mph)
Weight lifting (general light workout)
Stretching
370
330
330
330
290
280
220
180
590
590
510
480
460
440
440
440
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GETTING STARTED
Now that you know seven of the many reasons
why exercise is important for a person with
diabetes, you should ask yourself some questions.
142
143
144
Insulin or
Oral meds
(time taken)
Type of
exercise
Day
and
date
Exercise Record
Table 3
Time of day
(start/end)
Pre-exercise
blood sugar
Snack(s)eaten
(and times)
Blood sugars
during/after exercise
(and times)
Hypoglycemic
episodes
(and when)
145
Table 4
Examples of foods
< 80
< 4.5
8 oz Gatorade or milk**
or 4-6 oz juice**
80-150
4.5-8.3
> 150
> 8.3
None
< 80
< 4.5
8 oz Gatorade or milk** or
4 oz juice plus 1/2 sandwich
80-150
4.5-8.3
> 150
> 8.3
1/2 sandwich**
< 80
< 4.5
80-150
4.5-8.3
> 150
> 8.3
Whole sandwich
* Remember to also drink water, Gatorade or other fluids (one 8 oz glass for A, two 8 oz glasses for B, and three
8 oz glasses for C) before or during the exercise to prevent dehydration. This table is for a moderate degree of
exercise (e.g., walking, bicycling leisurely, shooting a basketball or mowing the lawn). If heavier exercise (e.g.,
jogging, bicycle race, basketball game or digging in the garden) is to be done for the same amount of time, then
more food may need to be added. Amounts vary for different people and the best way to learn is to do blood
sugars before and after the exercise and keep a record of the blood sugar values (see Table 3).
** Each of these represent 15 grams of carbohydrate which will last for about 30 minutes of moderate exercise.
A sandwich with meat or other protein lasts longer.
146
147
148
All insulins
by 10-50%
All insulins
by 10-50%
a.m. N or noon
a.m. N or noon
by 1/2 unit
by 1/2 unit
a.m. RAI or R
a.m. RAI or R
dinner RAI or R
(evening before)
(evening before)
dinner RAI or R
by 1/2 unit
by 1/2 unit
p.m. N or Lantus
p.m. N or Lantus
dinner or
dinner or
RAI or R
3 - 4 yrs.
Birth - 2 yrs.
RAI or R
Preschool
Infants
by 10-50%
All insulins
by 1/2 -1 unit
dinner RAI or R
by 1/2 -1 unit
RAI or R
a.m. N or noon
by 1/2 -1 unit
a.m. RAI or R
(evening before)
by 1/2 -1 unit
p.m. N or Lantus
dinner or
5 - 9 yrs.
School Age
by 10-50%
All insulins
by 1 unit
dinner RAI or R
by 1 unit
RAI or R
a.m. N or noon
by 1 unit
a.m. RAI or R
(evening before)
by 1 unit
p.m. N or Lantus
dinner or
10 - 12 yrs.
Pre-Teen
by 10-50%
All insulins
by 1-2 units
dinner RAI or R
by 1-2 units
RAI or R
a.m. N or noon
by 1-2 units
a.m. RAI or R
(evening before)
by 1-2 units
p.m. N or Lantus
dinner or
13 - 25 yrs.
College Age
Adolescents/
Appreciation is expressed to DeAnn Johnson, RN, CDE and others of the Barbara Davis Center staff who helped develop this table.
All Day
Evening
Afternoon
MidMorning
Before
Breakfast
Expected
Time of
Exercise
Table 5
Table 6
Suggestions for
Exercising Safely
Eat before heavy exercise
Try to have the blood sugar above 180
mg/dl (10 mmol/L) before heavy
exercise
Have extra snacks available during
exercise; some people use Gatorade, 48 oz, for every 30 minutes of vigorous
exercise
Always carry sugar
HYDRATION AND
EXERCISE
Proper hydration (drinking fluids) is
essential during exercise. Exercising during hot
weather requires special attention. Drinking
extra fluids should begin an hour or two before
starting to exercise. A general rule is to drink 8
oz of fluids for every 30 minutes of vigorous
activity. Liquids such as milk, Gatorade and
fruit juices help replace water, salts and
carbohydrates. Drinking Gatorade (or other
sports drinks) at half-hour intervals during
strenuous exercise works well for many people.
Table 4 recommends suggested fluid amounts
for different levels of activity.
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SUMMARY
150
DEFINITIONS
Abdomen: The area around the belly button.
The fatty tissue of the abdomen can be used as
an injection site.
Adrenaline (epinephrine): The excitatory
hormone. This normally increases early in
exercise and may result in an initial rise in the
blood sugar.
Aerobic: A continuous exercise usually lasting
25 minutes or longer.
Buttocks (seat): What a person sits on. The
fatty tissue of the buttocks can be used as an
injection site.
Delayed hypoglycemia: Low blood sugars
occurring 4-12 hours after heavy physical
exercise. This usually occurs as sugar leaves the
blood to replace depleted muscle sugar stores.
DPP: The Diabetes Prevention Program. A
study of 3,234 people who were overweight
and had impaired (not diabetic) oral glucose
tolerance tests. Exercise and weight loss (see
this chapter) reduced the development of
diabetes by 58 percent.
Glucagon: A hormone (like insulin) which also
is made in the islets of the pancreas. It has the
opposite effect of insulin and raises the blood
sugar.
151
Dear Coach,
This letter is on behalf of _____________________ who is participating in _______________
this year. Although we do not want to single out people with diabetes, there are things that
you need to be aware of to help _____________s performance and enjoyment of the sport.
Exercise is very important for children and adolescents with diabetes. The overall effect of
exercise is to lower blood sugar. We hope ______________ will take the right amount of insulin
and eat according to the anticipated activity for the day. However, even when these things are
done, there may be times, especially with increased activity, when he/she may have an insulin
reaction, a low blood sugar, a condition requiring immediate attention. The symptoms of an
insulin reaction include one or more of the following: shakiness, dizziness, sweating, rapid
onset of extreme hunger or tiredness and paleness. Some people complain of double vision and
headaches. You may also notice _________________s performance to suddenly become very
poor, or his/her overall mood may change to being very crabby or emotional.
If a low blood sugar occurs, a can of fruit juice, 8 oz of Gatorade, or two teaspoons of sugar
followed in five to 10 minutes by solid food (fruit, cheese and crackers or a sandwich) will help
correct this condition. He/She should rest for a minimum of ten minutes to let the blood
sugar return to normal. However, some children will still have a headache and may not feel like
continuing. We encourage families to be prepared for insulin reactions at all times by having
the proper foods available.
Many people with diabetes will change their insulin dose on days they anticipate a practice
or game. The scheduling (or cancellation) of these events ahead of time helps the person (and
parents) to be prepared. Again, it is very important for youth with diabetes to be involved in
sports. It helps with their sugar control and allows their insulin to work more effectively. A
person with diabetes should not be and does not want to be treated differently because of
having diabetes.
Please do not hesitate to call if you need more information or have any concerns. Our
phone number is ____________________.
Sincerely,